Expert opinion on the clinical use of a combination of antihistamines with leukotriene receptor antagonists in the management of allergic rhinitis in Indian settings
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20240697Keywords:
Allergic rhinitis, Montelukast, Antihistamines, Levocetirizine, Leukotriene receptor antagonistAbstract
Background: Various clinical studies have reported that the combination of montelukast and levocetirizine was effective in alleviating residual symptoms and the improvement of quality of life associated with allergic rhinitis. However, there was a dearth of data regarding the prescription practice among clinical practitioners. So, this study aims to gather clinicians' opinion regarding the use of antihistamines, with a special focus on the combined use of antihistamines with leukotriene receptor antagonists for the management of AR in Indian settings.
Methods: The multiple-response questionnaire-based survey involving 19 questions gathered information on current recommendations, clinical observations, clinical experience of specialists in AR management, and the use of montelukast with levocetirizine in routine settings.
Results: Out of 388 participants, approximately 84% of respondents preferred a combination of antihistamines and leukotriene receptor antagonists for managing AR. Additionally, 36% stated that 26 to 50% of patients presenting to routine practice may require montelukast and antihistamine combination as treatment. Around 61% endorsed the combination of antihistamines with leukotriene receptor antagonists as the preferred AR treatment strategy. In long-term AR management, 65% of clinicians rated montelukast with levocetirizine as excellent, and 78% of respondents reported montelukast confers additive benefits when combined with antihistamines.
Conclusions: The significant preference for the combined use of antihistamines and leukotriene receptor antagonists underscores their perceived efficacy in AR treatment. The combination of antihistamines with leukotriene receptor antagonists emerges as the favored strategy for managing AR.
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References
Akhouri S, House SA. Allergic Rhinitis. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2023.
Adsule SM, Misra D. Long-term treatment with montelukast and levocetirizine combination in persistent allergic rhinitis: review of recent evidence. J Indian Med Assoc. 2010;108(6):381-2.
Kumar RS, Jain MK, Kushwaha JS, Patil S, Patil V, Ghatak S, et al. Efficacy and Safety of Fluticasone Furoate and Oxymetazoline Nasal Spray: A Novel First Fixed Dose Combination for the Management of Allergic Rhinitis with Nasal Congestion. JAA. 2022;15:783-92.
Kiran M, Pawaskar L, Sheikh S, Waghambare P. Efficacy and Safety for the combination of Montelukast and Levocetirizine in patients of allergic rhinitis: Post Marketing Surveillance study. Ann Int Med Dent Res. 2021;7(5):61-70.
Baççıoğlu A. Role of leukotriene antagonists and antihistamines in treatment of allergic rhinitis and asthma comorbidity. J Med Updates. 2013;3(1):34-9.
Gupta V, Matreja PS. Efficacy of montelukast and levocetirizine as treatment for allergic rhinitis. J Aller Ther. 2010;1:103.
Ciebiada M, Górska-Ciebiada M, DuBuske LM, Górski P. Montelukast with desloratadine or levocetirizine for the treatment of persistent allergic rhinitis. Ann Allergy Asthma Immunol. 2006;97(5):664-71.
Mahatme MS, Dakhale GN, Tadke K, Hiware SK, Dudhgaonkar SD, Wankhede S. Comparison of efficacy, safety, and cost-effectiveness of montelukast-levocetirizine and montelukast-fexofenadine in patients of allergic rhinitis: A randomized, double-blind clinical trial. Indian J Pharmacol. 2016;48(6):649-53.
Ciebiada M, Gorska-Ciebiada M, Barylski M, Kmiecik T, Gorski P. Use of montelukast alone or in combination with desloratadine or levocetirizine in patients with persistent allergic rhinitis. Am J Rhinol Allergy. 2011;25:e1-6.
Liu G, Zhou X, Chen J, Liu F. Oral Antihistamines Alone vs in Combination with Leukotriene Receptor Antagonists for Allergic Rhinitis: A Meta-analysis. Otolaryngol Head Neck Surg. 2018;158(3):450-8.
Kim MK, Lee SY, Park HS, Yoon HJ, Kim SH, Cho YJ, et al. A randomized, multicenter, double-blind, phase iii study to evaluate the efficacy on allergic rhinitis and safety of a combination therapy of montelukast and levocetirizine in patients with asthma and allergic rhinitis. Clin Ther. 2018;40(7):1096-107.
Panchal S, Patil S, Barkate H. Evaluation of efficacy and safety of montelukast and levocetirizine FDC tablet compared to montelukast and levocetirizine tablet in patients with seasonal allergic rhinitis: a randomized, double blind, multicentre, phase III trial. Int J Otorhinolaryngol Head Neck Surg. 2020;7(1):83-90.